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Flashcards in Infectious Disease Deck (146)
1

Tonsillar pharyngitis
Posterior cervical lymphadenopathy
Fever

+maculopapular rash after amoxicillin or ampicillin administration

What is it?

EBV

Not a true allergy! Ok to take drug later

2

Common pathogens in cystic fibrosis related PNA

Gm - rod
- P. aeruginosa
- Burkholderia cepacia
- Stenotrophomonas

Hib, nontypeable

Strep pneumo

Staph aureus

3

Child with:
- fever
- rash (maculopapular) starting on face --> trunk and extremities

Prior to rash:
- cough
- coryza
- sneezing
- tearing

What is it?
What has been shown to reduce morbidity and mortality rates of pts w/ this infection?

Measles

-- can see leukopenia and thrombocytopenia

Vit A to reduce mortality
- helps immune enhancement
- helps GI and resp epi to regenerate

4

#1 cause otitis media

Treatment?

Strep pneumo (#1)

Then:
Hib
moraxella

Tx w/ amoxicillin x 10d

If tx and doesn't get better, conclude is HIb or Moraxella and give augment

5

Acute unilateral lypmhadenitis

Cause?
Most common cause?

Usually bacterial infection

#1 = Staph aureus
#2 = Group A strep

Tx = dicloxacillin to cover strep and staph

6

Prevent neonatal ophthalmic chlamydial infection

ONLY prenatal maternal testing + tx

Erythromycin is only effective for gonococcal conjunctivitis

7

Infant botulism transmitted by...

Ingesting food contaminated with C botulinum

Germ grows in gut --> makes toxin --> clinical signs

8

When do pts with genetic B cell deficiency begin to develop recurrent infections?

After 6 mo

No more passive ab from mom

9

3 most common causes of conjunctivitis in neonates

Chemical (via silver nitrate) - tx supportive management!
Gonococcal
Chlamydial

10

Gonococcal conjunctivitis (ophthalmia neonatorum)

Present at 2-5 day old

Copious purulent exudates
Eyelid swelling
Eyelid exudates

Dx:
- Gm stain w/ intracellular Gm- diplococci
- + Cx on THAYER MARTIN media

Tx:
- IM or IV ceftriaxone or cefotaxime
- hospitalization to assess tx response

Ppx:
- Erythromycin ophthalmic ointment within 1 hr birth

...if untreated --> corneal ulceration, scarring, blindness

11

Chlamydia vs Gonorrhea conjunctivitis

Chlamydia happens later (5-14 d) vs 2-5 d for gonorrhea

Chalmydia has more chemosis
-less eyelid swelling
- less purulent d/c - it is more mucoid
- blood stained eye discharge is characteristic

Tx:
- oral erythromycin

12

How do you dx early localized lyme disease?

Based solely on presence of erythema chronicum migrans

13

Tx lyme disease

Doxycycline
Amoxicillin
Cefuroxime

- Doxy used more b/c can also tx anaplasma phagocytophilum

DO NOT use doxy in kids < 8 yo and preggers

--> Oral amox or cefuroxime for kids < 8 yo and preggers

Disseminated dz --> ceftriaxone or penicillin G
DO NOT use steroids for bells palsy - just use same for erythema migrans

14

When is it ok to use tetracycline?

> 8 yo kid

15

What is the incubation period of varicella?

3 weeks

Most pts develop sx within 2 weeks of exposure

16

How effective is varicella vaccine after exposure?

70-100% 3-5 days of exposure

Not ok for > 5 days after exposure

17

Potential complications of varicella infection

Children - bacterial superinfection

Adults - pneumonia

18

Orbital cellulitis features

Pain w/ eye mvmts

Proptosis

Ophthalmoplegia

Diplopia

19

Most common predisposing factor for orbital cellulitis

Bacterial sinusitis

Use contrast CT to ID abscesses needing surgery

20

TORCH infections

Toxo
CMV
Congenital rubella
HSV
Syphilis

21

Toxoplasmosis
- risk
- effect on baby
- dx
- tx

- raw meat eating or cat feces

- intracranial calcifications*******
- chorioretinits
- hydrocephalus 2/2 aqueductal stenosis

Dx IgM immunosorbent agglutination assay

--> Tx mom spiramycin for 1st sem, pyrimethamine + sulfonamide afterward
--> Tx baby pyrimethamine + sulfonamide leucovorin

22

CMV
- risk
- effect on baby
- dx
- tx

#1 congenital infection

- periventricular calcifications*********
- chorioretinitis

- #1 cause sensorineural hearing loss
- seizures
- IUGR
- hepatosplenomegaly
- microcephaly

Dx culture or PCR

Prognosis poor

23

Rubella
- risk
- effect on baby
- dx
- tx

If 1st trimester infection --> 80% babies affected
- transmitted via resp droplets

- cataracts*****
- PDA, pulmonary stenosis
- blueberry muffin lesions 2/2 dermal erythropoiesis
- sensorineural hearing loss

Dx IgM titers

Prevent w/ immunizations

24

HSV
- risk
- effect on baby
- dx
- tx

Usually 2/2 passage through infected canal
Primary dz in mother has high rate of transmission

- Encephalitis
- herpetic (vesicular) lesions

Tx acyclovir

25

Syphillis
- risk
- effect on baby
- dx
- tx

Transplacental transmission

Often result in stillbirth, hydrops fetalis

Usually asymptomatic

If sx...

Early stage
- appear before 2 yo
- FTT
- maculopapular rash (esp on palms + soles)
- thrombocytopenia
- hepatosplenomegaly

Late stage
- skeletal --> saber shin, hutchinson teeth, saddle nose, clutton joints

Dx:
- VDRL or RPR first
- confirm w/ FTA-ABS

Tx:
- Parenteral PCN G

26

Causes of neonatal bacterial sepsis + associations

Group B strep & E. coli
- #1 causes of early and late onset sepsis

Staph aureus
- skin, bone, joint infections

Listeria
- early onset sepsis

Enterococcus
- sepsis in preterm

Coag-negative staph
- in intravascular catheters that are indwelling

Other Gm - bacteria (Klebs, Enteriobacter, P. aeruginosa)
- late onset sepsis, esp in infants in ICU

27

Fever of unknown origin

Lasting > 14 days in child
< 36

> 21 days in adolescent or adult

28

Fever without a focus

Lasting < 1 week in children < 36 mo old

29

Occult bacteremia (bacteremia w/o obvious focus) is usually 2/2 to

S pneumo
N meningitidis
H influenzae B
Salmonella

30

Fever in pts < 3 mo old..should consider what?

Meningitis
UTI
PNA

31

Tx bacteremia in children

< 1 mo old
- admit
- ppx abx for group B strep, listeria, e coli

Ceftriaxone if:
- look ok
- no source of fever
- WBC > 15,000

32

Causes of meningitis

< 3 mo old
- Group B strep
- Listeria
- E. coli

> 3 mo
- N. meningitides
- S. pneumo
- H. influenzae B

Sickle cell
- pneumococcal

CSF shunt infection
- Staph epi

33

Physical signs of meningitis

Bulging fontanelle in infants

+ Brudzinski (involuntary flexion of knees + hips after flexion of neck while supine)

+ Kernig (flexion of hip 90 deg w/ subsequent pain on extension of leg)

34

When does aseptic meningitis usually happen?

Summer
Fall

Origin usual viral

35

ppx for family contacts of pts w/ what meningitis causing organisms?

Give rifampin for contacts of:

H. influenza
N. meningitides

36

What are causes of arboviral encephalitis? Which one has worst prognosis?

St louis encephalitis (birds)

California encephalitis (rodents --> mosquitoes --> baby)

Western equine encephalitis (mosquitoes + birds)

Eastern equine encephalitis (mosquitoes + birds) --> poor prognosis

Colorado tick fever

37

Most common days osteo spreads in kids

#1 pathogen

Acute hematogenous spread

Staph aureus

38

Associations of osteo...

Sickle cell - Staph aureus, salmonella

Dog or cat bites - pasteurella

puncture wounds of foot through sneaker - pseudomonas

39

Dx osteo

Periosteal bone culture

Radiographs are only + 10-14 days after showing soft tissue swelling and periosteal elevation

MRI if radiographs neg but strong suspicion

40

How to determine response to therapy in osteo?

ESR
CRP

41

Hip pathology refers pain to..

the knee!

42

Dx septic arthritis

Arthrocentesis

WBC and ESR will be elevated

US good for septic arthritis of hip!

43

Reading ppd

>=5 mm ---> + if exposed to TB or immunocompromised

>=10 mm --> + if high risk (health care, homeless)

>=15 mm ---> + if low risk

prior BCG vaccine never contraindication for ppd

44

Side effects of Tb drugs

INH
Rifampin
Pyrazinamide
Streptomycin
Ethambutol
Ethionamide

INH
- hepatotoxicity
- neuritis

Rifampin
- hepatotoxicity
- thrombocytopenia

Pyrazinamide
- Hepatotoxicity

Streptomycin
- ototoxicity
- nephrotoxicity

Ethambutol
- ocular toxicity

Ethionamide
- hepatitis

45

Stages of pertussis infection

Stage 1 - catarrhal
- last 1-2 wks
- rhinorrhea, conj injection, cough

Stage 2 - paroxysmal stage
- 2-4 wks
- coughing spasms, inspiratory whoop, facial petechiae

Stage 3 - convalescent stage
- 1-2 weeks
- dec freq of sx

46

Dx pertussis

1st 4 weeks:
- Culture from nasopharyngeal secretions******** of B. pertussis is gold standard

After 4 wks:
- serology

47

Tx pertussis

Suppportive

Severe dz --> hospitalize

Erythromycin to shorten period of communicability but does not affect paroxysmal stage

Ppx ALL close contacts w/ erythromycin, even if immunized

48

Bartonella hensalae

Small red papules at site of inoculation appearing in LINEAR fashion

Chronic regional lymphadenitis
- start enlarging in 1-4 weeks and stay that way for 2 months

Parinaus oculoglandular syndrome happens after rubbing eye with hands after cat contact sometimes happen
- unilateral conjunctivitis
- preauricular lymphadenopathy
- cervical lymphadenopathy

49

How do you dx Bartonella hensalae?

Usually hx

Warthin Starry stain can see the gram negative bacilli

50

Tx bartonella hensalae

No tx usually resolves spontaneously

51

Complications of parvovirus B19

Aplastic crisis, esp if sickle cell +

Fetuses --> can develop fetal hydrops and death

52

Tx measles

Supporive

Vitamin A

Isolation

53

Complications w/ measles

Otitis media #1

PNA
Subacute sclerosing panencephalitis (1/1000 get this after measles)

54

Tx rocky mountain spotted fever

Rickettsia rickettsii

Pale rose-red maculopapular rash
Starts and palms and soels and spreads to entire body

Tetracycline
Doxycycline
--> ok in kids < 8 yo since only 1 dose

Chloramphenicol for tetracycline allergic

55

Complications of rocky mountain spotted fever

Rickettsial vasculitis causing gangrene fo digits, ear lobes, nose, scrotum, entire limbs

Neuro sequelae

56

Complications of varicella

2/2 infection w/ group A strep and staph aureus

PNA

Guillain Barre
encephalitis
Cerebellar ataxia

57

Tx scarlet fever

Penicillin

Erythromycin
Clindamycin
1st gen cephalosporins

58

Mumps

Viral infection

Painful enlargement of salivary glands (mainly parotid)
- can have erythema and swelling around Stenson's duct

Dx with hx; serum amylase elevation common

Tx - supportive

Complications
- menigoencephalitis
- orchitis (infertility rare)
- mild pancreatitis
- sensorineural deafness (very common with infection)

59

Dx HIV of newborns

All infants born to HIV + moms have + antibody test at birth b/c of passive transfer
- detection of antibody by ELISA and Western Blot
- passive antibodies last 15 months

Do HIV DNA PCR for infants

60

Mononucleosis
- sx
- dx
- tx
- complications

EBV spread via intimate contact and saliva

Dx
- typical clinical sx (fever, malaise, fatigue, HA, nausea)
- atypical lymphocytosis in periph blood

Tx
- supportive
- avoid contact sports for 2-3 weeks or until splenomegaly resolved

Complications:
- ampicillin rash

61

Pinworm

Enterbiasis (parasite)

Worms live in cecum, appendix, ileum, ascending colon

Hx of nocturnal pruritus ani --> suggest infection

Dx:
- inspection of worm under microscope
- tape test
- NO eosinophilia in enterbiasis

Tx:
- albendazole
- mebendazole
- pyrantel pamoate

62

Ascariasis

2/2 ascaris lumbricoides

Helminth

Human host ingests eggs --> larvae released and penetrate intestinal wall --> larvae migrate to lungs via venous circulation --> larvae break through lung tissue into alveolar spaces --> larvae travel up bronchial tree and are reswallowed --> adult worms formed

Colicky ab pain
Bile stained emesis

Tx:
- albendazole
- pyrantel pamoate
- mebendazole
- PIperazine if intestinal obstruction

63

Scabies

2/2 Sarcoptes scabiei

Transmission depends on extent and duration of physical contact

Fomite transmission rare

Burrow is classic lesion
- face spared in adults and older children

Tx:
- permethrin cream
- lindane (not for small infants)
- sulfur in petrolatum for < 2 mo old

Pruritus can persist for up to 2 weeks after treatment because of hyperssensitivity to mite antigens

64

Lice

Pediculus humanus corporis

Obligate parasites of human host

Risks:
- poor hygiene
- sex contact with infested person

Tx:
- Permethrin cream for body lice
- Petrolatum for eyelashes
- permethrin rinse for head lice and remove nits from hair with fine tooth comb
- launder all sheets in hot water

65

Hookworm

Ancylostoma duodenale
Necator americanus

Helminth

Causes:
- blood loss
- iron deficiency
- anemia
- protein malnutrition

Can have yellow-green pallor = chlorosis

Dx
- fecal exam for eggs

Tx:
- mebendazole
- albendazole
- pyrantel pamoate

66

Tx oral candidiasis

Topical nystatin solution

67

Tinea corporis

Ringworm 2/2 tricophyton rubrum

Dx:
- hyphae on KOH
- should not fluoresce with wood's lamp in corporis

Tx:
- topical antifungal

68

Tinea capitis

2/2 trichophyton tonsurans and microsporum canis

Wood's lamp:
- fluoresce blue-freen with Microsporum
- no fluorescence in Tricophyton

Tx:
- oral griseofulvin

Complications:
- inflammatory rxn can produce boggy granulomatous mass = kerion
- tx w/ griseofulvin + tapering dose steroid

69

Tx Coccidiomycosis

Primary dz is self limiting - no tx needed

Amphotericin B for severe
Fluconazole for meningitis 2/2 coccidiodes

Will have permanent immunity in normal host after recovery

70

Histoplasma

Bird droppings!

Acute pulm histoplasmosis - flu like sx
Chronic pulm histoplasmosis - opportunistic infection w/ centrilobular emphysema
Progressive disseminated histoplasmosis - infants + immunosuppressed --> fever, hepatosplenomegaly, anemia

Tx:
- disseminated histoplasmosis - amphotericin
- ppx itraconazole if immunodepressed and in prevalent area
- NSAID for sarcoid like disease

71

Otitis Media

Craniofacial anatomy adn eustachian tube dysfunction are responsible for development of OM

Otalgia
FEver
Ear pulling
Vomiting + diarrhea
Drainage not common

Tx:
- Amoxicillin for uncomplicated
- amoxicillin + clavulanic acid or cephalosporins if fail tx

72

Complications of otitis media

Recurrent OM - tx w/ myringotomy + tubes

Hearing loss

Perforation

MAstoiditis (redness and tenderness over mastoid bone)

Cholesteatoma (pocket of squamous epithelium in TM - need surgery)

Meningitis

Labyrinthitis (vertigo, nystagmus, tinnitus, hearing loss, vomiting)

73

Otitis Externa

Swimmer's ear

Usually 2/2 pseudomonas

Sx:
- ear pain worse by moving ear canal

Tx:
- topical abx

74

#1 cause of bacterial pharyngitis

Group A beta hemolytic Strep

Tx -
PCN
amoxicillin

75

Peritonsillar abscess

Usually 2/2 pharyngitis

Drooling
TOnsil bulges medially
Uvula deviates to NONinvolved side
Hot potato voice

IV abx needed
Surgical drainage may be needed

76

Retropharyngeal abscess

S. aureus usually causes

Lateral films revel soft tissue mass

Tx IV abx and drainage

77

Cervical lymphadenitis ddx

Ddx:
thyroglossal duct cyst
brainchial cleft cyst
cystic hygroma
mumps

78

12 mo old child brought to office because of barky cough

Fever
Runny nose

Sx getting worse

Trouble breathing

Laryngotracheobronchitis (Croup)
- usually 2/2 parainfluenza virus

Dx
- roentgenograms of nasopharynx and upper airway can show STEEPLE sign = narrow subbglotic space

Tx:
- tx at home
- watch for respiratory distress
- if stridor at rest --> racemic epinephrine + dexamethasone

Ddx:
- spasmodic croup (usually 2/2 allergy, GERD)
- bacterial tracheitis (usually 2/2 staph)
DIptheric croup
Epiglottitis

79

2 yo child p/w high fever + difficulty swallowing

Hoarse voice
Seated in tripod position
Drooling
Expiratory stridor
Nasal flaring
Retractions of suprasternal notch + supraclavicular and intercostal spaces

Epiglottitis
- acute inflamm of epiglottis --> respiratory distress + airway obstruction
- HiB #1 cause

Dx:
- history
- will see thumb print sign on xray

Tx:
- secure airway no matter what (intubation)
- 3rd gen cephalosporin (cefotaxime or ceftriaxone)
- ampicillin + sulbactam (Unasyn)

Notes:
DO NOT use tongue depressor to examine --> can have laryngospasm and cardiopulm arrest

80

6 mo old infant p/w 3 d hx of URI, wheezy cough, dyspnea

Tachypnic
Alae nasi flare
Accessory muscle usage

Desaturation of O2 to 92%

Bronchiolitis!
- lower respiratory infection
- usually 2/2 RSV
- peak incidence 6 mo age

CXR
- hyperinflation of lungs
- peribronchial thickening
- atelectasis

Virus detection in nasopharyngeal secretions

Tx
- supportive
- trial of bronchiodilator
- aerosolized epi
- NOT steroids
- Ribavirin if impending respiratory failure

81

Pneumonia

Inflammation of pulmonary tissue assoc w/ consolidation of alveolar spaces

Classic triad:
- fever
- tachypnea
- cough

82

Staccato cough pneumonia....

Chlamydia

83

CXR appearance of PNA
- vira
- bacterial
- myco
- chlamydia
- aspiration

Viral = diffuse streaky infiltrates

Bacterial = lobar consolidation

Mycoplasma = interstitial most common in lower lobes

Chlamydia = hyperinflation or ground glass appearance

Aspiration = alveolar and reticular infiltrates

84

Dx Mycoplasma pneumonia

Serum cold hemagluttinin

+ IgM M. pneumo titer

85

Tx chlamydia pneumonia

Usually in 6wks-6mo old kids

Erythromycin ethyl succinate drops PO

86

Tx Group B strep, E. coli, Listeria PNA

Usually in birth - 2 mo old kids

Ampicillin + aminoglycoside
Ampicillin + 3rd gen cephalosporin IV

87

Tx S. pneumo, H. influenzae, and Staph PNA

Usually 2mo-5yo babies

Cephalosporin (cefuroxime or ceftriaxone) IV

Amoxicillin
Amoxicillin clavulanate
Erythomycin + sulfasoxazole

88

Tx M. pneumoniae PNA

Usually > 5 yo

Erythromycin
Azithromycin
Clarithromycin

89

Cause of acute rheumatic fever

Infection w/ group A beta-hemolytic strep

90

Presentation of acute rheumatic fever

Presents 1-3 weeks after preceding strep pharyngitis

91

JONES criteria

To dx rheumatic fever

2 major criteria

1 major + 2 minor + preceeding strep infection + chorea w/o explanation

Joints (migratory polyarthritis)
Carditis
Nodules (SubQ)
Erythema marginatum
Sydenham chorea

Minor:
- fever
- arthralgia
- elevated ESR, CRP
- prolonged PR
- evidence of preceding strep pharyngitis

92

Tx acute rheumatic fever

Tx strep

Monthly PCN ppx

Steroids if there is carditis w/ heart failure

93

Causes of endocarditis

Strep viridans #1

Dental procedures - Strep virdans

IVDU - Pseudomonas, Serratia

Open heart surgery - fungal causes

94

Presentation of endocarditis

Fever

Chills

New murmurs

Osler nodes (tender nodules on finger and toe pads)

Janeway lesions (painless hemorrhage lesions on palms and soles)

splinter hemorrhages

95

Dx and Tx endocarditis

Dx - + blood cx

Tx
- 4-6 weeks abx

96

Cardiac conditions recommended to ppx against endocarditis

Prosthetic valves

Previous endocarditis

Pulm shunts or conduits

Congenital heart disease

MVP w/ regurg or thickened valves

97

Not needed for ppx against endocarditis

Isolated secundum ASD

Surgical repair ASD, VSD, PDA

CABG

MVP w/o regurg or thickened valves

Kawasaki w/o valvular dysfunction

Rheumatic fever w/o valve issues

Pacemakers
Defibrillators

98

Abx to ppx against endocarditis if undergoing dental, oral, resp, or esophageal procedure

Amoxicillin

NPO - ampicillin

99

Abx to ppx against endocarditis if undergoing GI or GU procedure

Ampicillin + gentamicin

or

Vanco + gentamicin

100

Rotavirus

Watery diarrhea
7-10 d

+/- 3-4 d vomiting
+/- Fever

101

Which e. coli is seen where?

Enteropathogenic - nurseries + day care

Enterotoxigenic - traveler's

Enterohemorrhagic - HUS

102

How do you get Salmonella food poisoning?

Infected animals
Eggs
Milk
Poultry

103

How do you get shigella?

Person to person

Food

104

How do you get Campylobacter?

person to person

Food

105

How do you get Yersinia?

Pets

Food

Can develop arthritis + rash

106

How fast does food poisoning w/ staph aureus happen?

12h

107

Giardia sx

Anorexia
Nausea
Ab distention
Watery diarrhea
Wt loss

108

Cryptosporidium presentation

mild diarrhea in immunocompetent infants

Severe diarrhea in AIDS

109

When do you tx pathogenic diarrhea w/ abx?

Salmonella
Shigella
Campylobacter
Yersinia
C. diff
Entamoeba
Giardia

NOT Salmonella - can prolong carrier state
- but can tx if < 3 mo age
- toxic pt
- disseminated dz
- salmonella typhi

Shigella
- TMP/SMX

Campylobacter is self limited
- erythromycin can speed recovery and limit carrier state

Yersinia
- none
- can give aminoglycosides + 3rd gen cephalosporin for < 3 mo

C diff
- metronidazole
- vanco

Entamoeba
- metronidazole

Giardia
- metronidazole
- furazolidone

110

Common causes of chronic diarrhea

Lactase deficiency

IBS

IBD

Giardiasis

CF

Celiac

Lactose intolerance

111

Incidence of UTIs in age groups - which sex is more?

< 2 yo
- boys, esp uncirc

> 2 yo
- girls

112

Sx UTI

Cystitis (dysuria, urgency, frequency) often absent in children

UTI in infants - fever, FTT, wt loss, vomiting, diarrhea

Older kids - fever, ab pain, hematuria, enuresis

113

Dx UTI

Urine cx

114

Tx UTI

Neonate
- hospitalize
- IV ampicillin + gentamicin

Older kids
- IV ceftriaxone/ampicillin + aminoglycoside if need hospitalization
- TMP/SMX or amoxicillin if outpatient

115

UTI follow up

Repeat UA 1 wk after complete therapy

Renal US to r/o hydronephrosis or abscesses

VCUG in::
- < 5 yo
- febrile UTI
- girls with > 2 UTI
- boy w/ UTI
...if suspect reflux, test with DMSA to see if there is renal scarring

RIsk developing renal insufficiency

116

Why do you give high dose amoxicillin for otitis media?

High resistances of Strep pneumo
- via penicillin binding protein

Hib and Moraxella via beta lactamases

117

If see an ear and it is not bulging, it is just fluid behind the ear, what is it?

Viral

If it is bulging and erythematous, it is ear infection!

118

Gonorrhea
- presentation
- Dx
- Tx
- complications

Neisseria gonorrhae

Presentation:
- varies
- urethritis
- cervicitis
- dyuria
-asymptomatic
- polyarthralgias if disseminated

Dx:
- cx for gonorrhea
- Gm stain --> Gm - intracellular diplococci in PMN cells
- also test for syphilis and HIV

Tx:
- ceftriaxone
- doxy or azithro for concaminant Chlamydia

Complications
- fitz hugh curtis
- PID

119

Fitz Hugh Curtis

Complication of gonococcal infection

RUQ pain +/- salpingitis

Seeds liver capsule --> perihepatitis

120

Chlamydia
- presentation
- Dx
- Tx
- complications

Intracellular obligate parasites

Presentation:
- Urethritis
- FHC syndrome
- PID
- asymptomatic
- mucoid dicharge

Dx:
- chlamydia cx

Tx:
- azithromycin or doxy
- erythromycin for preggers
- test and tx all sex partners

Complications
- fitz hugh curtis
- salpingitis

121

Trichomoniasis
- presentation
- Dx
- Tx
- complications

Trichomonas vaginalis (protozoa)

Presentation:
- pruritus
- foul smelling vaginal d/c
- males usually no sx
- strawberry cervix

Dx
- motile protozoan on wet mount

Tx:
- metronidazole

Complications:
- premature rupture of membranes, LBW infants, infertility
- epididymitis, prostatic involvement, penile ulceration

122

Herpes
- presentation
- Dx
- Tx
- complications

Double stranded
Enveloped
DNA virus

HSV2 is more genital
HSV1 is more lips

Presentation:
- fever
- dysuria
- ulcers
- regional adenopathy

Dx:
- Tzanck stain (multinuclear giant cells + intranuclear inclusions)

Tx:
- acyclovir
- valacyclovir

Complications:
- risk factor for HIV
- perinatal transmission

123

Pupura fulminans

Life threatening condition

Seen w/ bacteria infections
- N. meningitidis
- strep pneumo

P/w blue or black hemorrhagic purpuric lesions

124

Types of Croup

spasmodic croup (recurrent croup)
- type of croup that develops quickly and may happen in a child with a mild cold.
- The barking cough usually begins at night and is not accompanied by fever.
- Spasmodic croup has a tendency to come back again (recur).
- those who are prone to spasmodic croup often still develop the disease into late childhood and even into adulthood

vs infectious...

laryngotracheitis (viral croup)
laryngotracheobronchitis (viral)
laryngotracheobronchopneumonitis (bacterial)

125

Tx croup

Supportive

Steroids, racemic epi prn

126

Risk to fetus if mom gets parvovirus

Hydrous fetalis

This is generalized edema

High output congestive failure due to aplastic anemia causes edema

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New dx of rhemumatic fever - waht do you do?

Tx w/ anx to eradicate GAS regardless of presence or absence of pharyngitis at time of dx

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When do you ppx w/ abx in pts w/ hx of rheumatic fever against recurrent GAS pharyngitis?

IM penicillin G q4 weeks

Rheumatic fever 1/o carditis - ppx 5 years or utnil 21 yo (whichever longer)

Rheumatic fever w/ carditis but no residual heart or valvular dz by clinical or echo criteria - ppx 10 years or until 21 yo (whichever longer)

Rheumatic fever w/ carditis + persistent heart or valvular dz - ppx 10 years or until 40 yo whichever is longer

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Tx enterobium vermicularis

Mebendazole

130

Seizure causing pathogens

HHV 6

Shigella

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Tx listeria

Ampicillin

132

#1 cause of sepsis in < 1 mo

Group B strep

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Blood in CSF + encephalitis...what do you suspect?

HSV

134

Tx pasturella multocida

Augmentin

If allergy --> clinda

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Parinaud's Oculoglandular syndrome associated with...

Bartonella henselae

Is is a combo of granulomatous conjunctivitis in one eye, and swollen lymph nodes in front of the ear on the same side

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When do you follow up on elevated LFTs in EBV?

1-2 weeks

If still elevated (usually is transient), trend out

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Tx Rickettsia

Doxycycline no matter how old the patient

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Pathogen giving you anuria + diarrhea

E. coli O157:H7
- HUS
- Enterohemorrhagic diarrhea

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Follicles + inflammatory changes in conjunctiva of eye

Neovascularization in cornea

Immigrant

Trachoma 2/2 C. trachomatis serotype A-C

Can also cause nasal discharge as it moves

Tx: Topical tetracycline or oral azithromycin

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Cholesteatomas

Can be congenital or aquired 2/2 chronic middle ear dz

New onset hearing loss or chronic ear drainage despite abx are typical presenting sx

Granulation tissue and skin debris may be seen within retraction pockets of TM on otoscopy

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# 1 predisposing factor for acute bacterial sinusitis

Viral URI

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Tx minor cat bite wounds

Amoxicillin/clavulanate

Pasturella!

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Tx bacterial menigitis in infants and children > 1 mo

IV vanco + ceftriaxone/cefotaxime
- vanco for s. pneumo
- ceftriaxone for neisseria

Consider dexamethasone for Hib

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Tx GBS + mothers

2 doses ampicillin 4 hrs before birth

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TB meningitis CT with contrast finding

CT with contrast is good for dx!

Exudate in basal cisterns that shows enhancement by contrast material is typical

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Leptospirosis

#1 zoonotic infection worldwide

Often mild or subacute

Hx exposure to dogs, cats, levestock

2 phases: anicteric and icteric

Can have meningitic sx

Tx:
- PCN
- tetracycline